Characterization of Non-Ischemic Dilated Cardiomyopathy in a Native Tanzanian Cohort: MOYO Study.

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Global Heart Pub Date : 2024-02-29 eCollection Date: 2024-01-01 DOI:10.5334/gh.1298

Lulu Said Fundikira, Pilly Chillo, Mohamed Z Alimohamed, Henry Mayala, Engerasiya Kifai, Geofrey M Aloyce, Appolinary Kamuhabwa, Gideon Kwesigabo, Linda W van Laake, Folkert W Asselbergs

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Abstract

Background: Non-ischemic dilated cardiomyopathy (NIDCM) is a common cause of heart failure with progressive tendency. The disease occurs in one in every 2,500 individuals in the developed world, with high morbidity and mortality. However, detailed data on the role of NIDCM in heart failure in Tanzania is lacking.

Aim: To characterize NIDCM in a Tanzanian cohort with respect to demographics, clinical profile, imaging findings and management.

Methods: Characterization of non-ischemic dilated cardioMyOpathY in a native Tanzanian cOhort (MOYO) is a prospective cohort study of NIDCM patients seen at the Jakaya Kikwete Cardiac Institute. Patients aged ≥18 years with a clinical diagnosis of heart failure, an ejection fraction of ≤45% on echocardiography and no evidence of ischemia were enrolled. Clinical data, echocardiography, electrocardiography (ECG), coronary angiography and stress ECG information were collected from February 2020 to March 2022.

Results: Of 402 patients, n = 220 (54.7%) were males with a median (IQR) age of 55.0 (41.0, 66.0) years. Causes of NIDCM were presumably hypertensive n = 218 (54.2%), idiopathic n = 116 (28.9%), PPCM n = 45 (11.2%), alcoholic n = 10 (2.5%) and other causes n = 13 (3.2%). The most common presenting symptoms were dyspnea n = 342 (85.1%), with the majority of patients presenting with New York Heart Association (NYHA) Class III n = 195 (48.5%). The mean (SD) left ventricular ejection fraction (LVEF) was 29.4% (±7.7), and severe systolic dysfunction (LVEF <30%) was common n = 208 (51.7%). Compared with other forms of DCM, idiopathic DCM patients were significantly younger, had more advanced NYHA class (p < 0.001) and presented more often with left bundle branch block on ECG (p = 0.0042). There was suboptimal use of novel guidelines recommended medications ARNI n = 10 (2.5%) and SGLT2 2-inhibitors n = 2 (0.5%).

Conclusions: In our Tanzanian cohort, the majority of patients with NIDCM have an identified underlying cause, and they present at late stages of the disease. Patients with idiopathic DCM are younger with more severe disease compared to other forms of NIDCM.

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坦桑尼亚本土队列中非缺血性扩张型心肌病的特征：MOYO 研究。

背景：非缺血性扩张型心肌病（NIDCM非缺血性扩张型心肌病（NIDCM）是导致心力衰竭的常见病因，具有进行性趋势。在发达国家，每 2500 人中就有一人患有此病，发病率和死亡率都很高。然而，坦桑尼亚缺乏有关 NIDCM 在心力衰竭中所起作用的详细数据。目的：从人口统计学、临床概况、影像学检查结果和管理等方面描述坦桑尼亚队列中 NIDCM 的特征：方法：坦桑尼亚本地人群中的非缺血性扩张型心肌病（MOYO）是一项前瞻性队列研究，研究对象是在 Jakaya Kikwete 心脏研究所就诊的 NIDCM 患者。研究对象为年龄≥18 岁、临床诊断为心力衰竭、超声心动图检查射血分数≤45% 且无缺血迹象的患者。临床数据、超声心动图、心电图、冠状动脉造影和负荷心电图信息的收集时间为2020年2月至2022年3月：在 402 名患者中，n = 220（54.7%）为男性，中位（IQR）年龄为 55.0（41.0，66.0）岁。NIDCM 的病因推测为高血压 n = 218（54.2%）、特发性 n = 116（28.9%）、PPCM n = 45（11.2%）、酒精性 n = 10（2.5%）和其他原因 n = 13（3.2%）。最常见的症状是呼吸困难 n = 342（85.1%），大多数患者为纽约心脏协会（NYHA）III 级 n = 195（48.5%）。左心室射血分数（LVEF）的平均值（标度）为 29.4% (±7.7)，严重收缩功能障碍（LVEF 结论：左心室射血分数（LVEF）的平均值（标度）为 29.4% (±7.7)）：在我们的坦桑尼亚队列中，大多数 NIDCM 患者的病因已被确定，而且他们的发病已进入晚期。与其他形式的 NIDCM 相比，特发性 DCM 患者更年轻，病情更严重。

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来源期刊

Global Heart Medicine-Cardiology and Cardiovascular Medicine

CiteScore

5.70

自引率

5.40%

发文量

审稿时长

5 weeks

期刊介绍： Global Heart offers a forum for dialogue and education on research, developments, trends, solutions and public health programs related to the prevention and control of cardiovascular diseases (CVDs) worldwide, with a special focus on low- and middle-income countries (LMICs). Manuscripts should address not only the extent or epidemiology of the problem, but also describe interventions to effectively control and prevent CVDs and the underlying factors. The emphasis should be on approaches applicable in settings with limited resources. Economic evaluations of successful interventions are particularly welcome. We will also consider negative findings if important. While reports of hospital or clinic-based treatments are not excluded, particularly if they have broad implications for cost-effective disease control or prevention, we give priority to papers addressing community-based activities. We encourage submissions on cardiovascular surveillance and health policies, professional education, ethical issues and technological innovations related to prevention. Global Heart is particularly interested in publishing data from updated national or regional demographic health surveys, World Health Organization or Global Burden of Disease data, large clinical disease databases or registries. Systematic reviews or meta-analyses on globally relevant topics are welcome. We will also consider clinical research that has special relevance to LMICs, e.g. using validated instruments to assess health-related quality-of-life in patients from LMICs, innovative diagnostic-therapeutic applications, real-world effectiveness clinical trials, research methods (innovative methodologic papers, with emphasis on low-cost research methods or novel application of methods in low resource settings), and papers pertaining to cardiovascular health promotion and policy (quantitative evaluation of health programs.